Direct Approach Care Limited

“We assessed the quality statements for the key questions of safe, effective, caring, responsive and well-led. We found the provider was in breach of the regulations in relation to safe care including safeguarding, governance and oversight, duty of candour and safety of the premises.”

“We assessed the service against ‘Right support, right care, right culture.’ This guidance supported judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choice, independence, and access to local communities that most people take for granted. We found the service had demonstrated an understanding of this guidance and were meeting them.”

“Improvements were needed regarding the safe management of medicines, safe transitions, risk management, safeguarding, lessons learned, positive behaviour support plans, recruitment, induction for staff, the safety of the premises, infection prevention control, duty of candour, and governance of the service.”

“People’s medicines had not been managed safely, lack of effective oversight of medicines had meant incorrect medicines had been administered to 1 person for a prolonged period.”

“Transitions between hospital and the home were not safe because the person’s needs were not reassessed when they returned to the service, and their medicines were not reconciled.”

“Risk management plans to guide staff in the use of physical interventions were not individually detailed, staff had received training but were not supported to know what specific intervention a person needed. People were at risk of harm from disproportionate and/or unnecessary restraint.”

“Opportunities to learn lessons to avoid reoccurrence of incidents had been missed because recording of safety incidents and staff debriefs were either not done or did not have sufficient detail to allow for analysis and review.”

“Recruitment practices were unsafe, recruitment files did not include the documentation required by the regulations. A sponsored staff was working beyond their permitted hours. New staff had not received the robust induction included in the provider’s policy.”

“Some aspects of the premises were unsafe; not all bedroom doors were fire doors or had intumescent strips. One bedroom door was missing. Some radiator covers were missing. One window did not have a restrictor in place, and it was possible to climb out of it. Cleaning chemicals were not stored securely. Regular legionella checks had not been recorded.”

“Some fire safety checks had been completed on a regular basis by staff, this included fire drills. Records relating to fire drills needed to improve to include who was present.”

“We observed poor infection prevention control (IPC) practices.”

“People, their families and other agencies had been involved in assessments and care planning. Reassessments and reviews had not always been done by the provider or had not been recorded. Care plans and risk management plans were in place but lacked some details necessary to sufficiently guide staff. Some staff were unable to access the risk assessments in the electronic care records and did not have access to paper records in the office.”

“Rotas showed people received the level of support they were assessed as needing. We observed sufficient staff to be on duty when we visited. People were supported to make decisions about day-to-day things such as clothing, food and drink and how…”